MEDICARE: PEAK VASCULAR ACCESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1639936990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK VASCULAR ACCESS, LLC

Provider Business Mailing Address
First Line	:	12101 PALISADES PKWY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-1244
Country	:	US
Telephone Number	:	512-680-6619
Fax Number	:

Provider Business Practice Location Address
First Line	:	12101 PALISADES PKWY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-1244
Country	:	US
Telephone Number	:	512-680-6619
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	TYLER PAYNE
Credential	:
Telephone Number	:	512-680-6619

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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